Feds to investigate Georgia’s Medicaid backlog

Nearly 89,000 people who applied for health coverage through the online marketplace at HealthCare.gov discovered they could be eligible for Georgia’s Medicaid program. But just over 13,000 of them, about 15 percent, have learned whether they will indeed get coverage. Many of the rest sit trapped in governmental limbo despite the marketplace’s open enrollment period having ended on March 31.

The Centers for Medicare & Medicaid Services (CMS) said in a July 9 letter to Georgia’s Medicaid chief that it will look at how many people are being affected, how long they have been waiting, and what technical challenges or gaps have contributed to the “substantial backlog.”

The backlog stems, in part, from persistent technical troubles that prevented application data from seamlessly transferring from the federal system to the state. Instead, the state said it didn’t begin getting the full set of data it needs to determine Medicaid eligibility until May 1 and has been working to process the applications ever since.

“We are individually processing these files as quickly as possible and comparing applicants through the (federal marketplace) with people who have also applied for Medicaid directly through the state,” Georgia Department of Community Health spokeswoman Pam Keene said Tuesday in an email to The Atlanta Journal-Constitution.

Keene said there is no estimated time frame for when the state hopes to have processed all of the applications. Meanwhile, some people may have ended up applying directly through the state.

HealthCare.gov, a key element of the Affordable Care Act, was supposed to be a one-stop shop for consumers. They would enter their information once, then be directed to private health insurance options or to Medicaid if their income qualified. But the marketplace computer system couldn’t pass along data to a number of systems in other states, which were outdated in many cases.

Nationwide, more than a dozen states are struggling to clear backlogs of hundreds of thousands of people who tried to sign up for Medicaid coverage through the marketplace. Many, including Georgia, faced daunting technical problems. Others were overwhelmed by the sheer number of applicants. Nearly 7 million marketplace applicants were deemed Medicaid eligible.

In addition to Georgia, CMS plans to review backlog problems in six more states, including North Carolina. It is also demanding that a half-dozen others, including Tennessee, submit written plans of how to solve gaps in Medicaid eligibility and enrollment systems.

“A lot of states had to really make significant upgrades to their Medicaid eligibility systems or build wholly new systems,” said Samantha Artiga, an expert with the nonprofit Kaiser Family Foundation.

States are typically supposed to process some types of Medicaid applications within 45 days. It’s been more than 70 days since Georgia’s technical glitches were fixed.

The would-be enrollees in limbo are potentially Medicaid eligible under the state’s current guidelines. They don’t include the estimated 650,000 or so Georgians who would have been eligible if Gov. Nathan Deal had opted to expand Medicaid under Obamacare. Deal has said repeatedly that the state can’t afford to expand an already massive and costly program. Medicaid provides health coverage to roughly 1.7 million low-income children, pregnant women, the elderly and the disabled. It does not cover healthy single adults.

Georgia’s backlog troubles may be a sign that the state isn’t investing enough in new technologies and other resources to make sure people who are eligible for Medicaid actually get covered, said Tim Sweeney, a health care expert with the Georgia Budget and Policy Institute. Sweeney added that many of the people stuck in Medicaid limbo are likely children.

“Increasing access to those who are eligible should be a higher priority,” he said. “It should be a goal to get all of those kids enrolled.”